促红细胞生成素水平在预测重症急性肾损伤后长期预后中的作用。

The Role of Erythropoietin Levels in Predicting Long-Term Outcomes following Severe Acute Kidney Injury.

机构信息

Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

出版信息

Blood Purif. 2023;52(9-10):793-801. doi: 10.1159/000531954. Epub 2023 Aug 29.

DOI:10.1159/000531954

PMID:37643588

Abstract

INTRODUCTION

Acute kidney injury (AKI) survivors are at an increased risk of chronic kidney disease, end-stage kidney disease, and mortality. Little is known about the effect of erythropoietin (EPO), a kidney-producing hormone, in post-AKI setting. We aimed to investigate the role of EPO as a predictor of long-term outcomes in post-severe AKI survivors.

METHODS

We performed a retrospective analysis of post-AKI cohort conducted between August 2018 and December 2021. Adults who survived severe AKI stages 2-3 were enrolled. Serum EPO was obtained at 1 month after hospital discharge. We explored whether EPO level could predict long-term kidney outcomes at 12 months including mortality, kidney replacement therapy, doubling serum creatinine, and major adverse kidney events at 365 days.

RESULTS

One hundred and twelve patients were enrolled. Median EPO level was significantly higher in non-survivors than survivors (28.9 [interquartile range: 16.2-50.7] versus 11.6 mU/mL [7.5-22.3], p = 0.003). The best EPO level cut-off was 16.2 mU/mL (sensitivity 77.8%, specificity 62.1%). Serum EPO predicted 12-month mortality with an area under the curve (AUC) of 0.69. Combining clinical model using age, baseline, and discharge kidney function with serum EPO improved prediction with AUC of 0.74. Multivariable analysis demonstrated that high-level of EPO group had significantly higher mortality compared with low-level EPO group (15.2% vs. 3.0%, p = 0.020). Hematocrit was significantly lower in high-level EPO group compared with low-level EPO group at 12 months (33.4 ± 1.1% vs. 36.0 ± 0.9%, p = 0.038).

CONCLUSIONS

Plasma EPO appears to be a useful marker for predicting long-term outcome in post-severe AKI survivors.

摘要

简介

急性肾损伤（AKI）幸存者患慢性肾脏病、终末期肾病和死亡的风险增加。关于肾产生的激素促红细胞生成素（EPO）在 AKI 后的作用知之甚少。我们旨在研究 EPO 作为预测严重 AKI 幸存者长期预后的指标的作用。

方法

我们对 2018 年 8 月至 2021 年 12 月进行的 AKI 后队列进行了回顾性分析。纳入了存活严重 AKI 2-3 期的成年人。在出院后 1 个月时获得血清 EPO。我们探讨了 EPO 水平是否可以预测 12 个月时的长期肾脏结局，包括死亡率、肾脏替代治疗、血清肌酐加倍和 365 天内主要不良肾脏事件。

结果

共纳入 112 名患者。非幸存者的中位 EPO 水平明显高于幸存者（28.9 [四分位距：16.2-50.7] 与 11.6 mU/mL [7.5-22.3]，p = 0.003）。最佳 EPO 水平截断值为 16.2 mU/mL（敏感性 77.8%，特异性 62.1%）。血清 EPO 预测 12 个月死亡率的曲线下面积（AUC）为 0.69。将年龄、基线和出院时的肾功能与血清 EPO 相结合的临床模型进行组合，可以提高预测值，AUC 为 0.74。多变量分析表明，高水平 EPO 组的死亡率明显高于低水平 EPO 组（15.2% vs. 3.0%，p = 0.020）。与低水平 EPO 组相比，高水平 EPO 组在 12 个月时的红细胞压积明显降低（33.4 ± 1.1% vs. 36.0 ± 0.9%，p = 0.038）。